Provider Demographics
NPI:1013547231
Name:MACIAS, GUILLERMO MARQUEZ SR
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:MARQUEZ
Last Name:MACIAS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 W SAM HOUSTON PKWY N
Mailing Address - Street 2:STE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041-8224
Mailing Address - Country:US
Mailing Address - Phone:713-402-7824
Mailing Address - Fax:713-570-0196
Practice Address - Street 1:908 SOUTHMORE AVE STE 100
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77502-1120
Practice Address - Country:US
Practice Address - Phone:713-554-1091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144288363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily